Look out, Allergan: Doctor surveys show the 'Botox competitive threat is real'

Analysts have previously signaled that market share for Allergan’s top-selling Botox should be safe even after new competitors show up. But new survey results indicate otherwise.

A poll of 100 high-volume U.S. aesthetic physicians, conducted by Bernstein, suggests that forthcoming entrants from Revance, Evolus and Hugel could grab up to 33% to 34% of the market, Bernstein analyst Ronny Gal wrote to clients Thursday. Revance would capture the lion’s share at 18%, with the other two companies splitting a 13% share, according to the results.

Those figures aren’t exactly in line with Gal’s own model, which puts market penetration for the newcomers at 19% altogether. But he and his colleagues “expect Botox to also lose pricing power,” slowing the product’s compound annual growth rate to 4%, compared with the 12% it’s seen over the last five years.

The “Botox competitive threat is real,” Gal concluded.

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That’s a departure from what he and other analysts said just last month after Revance’s long-acting RT002 candidate aced a pair of phase 3 studies.

There’s “not much evidence that there is a need for more/better toxins in the aesthetic market ... When it comes to mass luxury, most of us still run in branded sneakers and eat branded ice cream,” he wrote at the time. “The cash-pay bundle of aesthetics products that Allergan offers is a significant barrier to entry” for any future rivals, Leerink Partners’ Seamus Fernandez agreed in his own note to clients.

Allergan, for its part, isn’t convinced that “longer lasting” necessarily means “better” when it comes to product selection. Patients have more freedom to choose their timing with a shorter-acting product. “When you have the ability to take a treatment and then you get to control when you take your next treatment, that’s a certain amount of balance,” Mitchell Brin, Allergan’s Chief Scientific Officer for Botox, said in an interview during the J.P. Morgan Healthcare Conference earlier this month.

“If you have an unwanted event, you want that event ... to go away in a reasonable period of time,” he added.

In his own survey, though, Wells Fargo’s David Maris found earlier this month that 44% of physicians said they thought Botox’s duration was ideal or nearly ideal, while 56% said they would prefer a longer duration. 

Maris cautioned against putting too much stock into the results, however.

“We note that doctors often say things like this before an approval ... but the reality is that many patients demand Botox by brand and doctors have not switched neurotoxins a great deal historically,” he wrote to clients.